Academic Committee

Objectives

To coordinate the academic activities of the various OBGYN Societies and Clubs of Kerala

To facilitate teacher training programmes in Kerala.

To Improve communication skills for OBGYN Doctors.

To strengthen ethical OBGYN practice in Kerala

To promote interest in OBGYN among undergraduate students.

To improve awareness on OBGYN issues among Public

Using the 10 Robson Groups to examine the caesarean section rate

The number of babies being born by caesarean section is increasing acrossAustralia. There are a number of risks associated with caesarean section – both for the mother and the baby, and over the longer term. Therefore a rising rate is regarded as a clinical risk, and it is important to investigate the appropriateness of caesarean sections. At the Women’s we have worked hard over the last 12 months to address this rising rate and our caesarean section rate is beginning to fall as shown in the report.

How did we change the rate?

The first step in reversing this trend was to understand which women were having caesarean sections. As a tertiary hospital, we often assume that our complex patient mix contributes to the higher caesarean section rate. However, closer examination by the Clinical Practice Improvement Unit (CPIU) has identified exactly which types of women are having caesarean section births. The CPIU used the ‘Robson Framework’ which allows us to divide the women who gave birth into ten groups, based on specific characteristics. We then work out the caesarean section rate for each of the ten groups, and calculate which group is are significantly increasing our caesarean section rate. This analysis showed:

Robson Groups 1 – 10

Calender year 2005

Women in this group

C/S section births and rate

Contribution to overall C/S rate

Group 1, first-time-mums, single pregnancy, head down, 37weeks’ or more, spontaneous labour

1595

246 = 15%

15%

Group 2, first-time-mums, single pregnancy, head down, 37weeks’ or more, induced or no labour

800

341 = 43%

21%

Group 3, not first-time mums, single pregnancy, head down, 37weeks’ or more, spontaneous labour

1508

55 = 4%

3%

Group 4, not first-time-mums, single pregnancy, head down, 37weeks’ or more, induced or no labour

497

115 = 23%

7%

Group 5, women who had a previous C/S, single pregnancy, head down, 37weeks or more

530

408 = 77%

25%

Group 6, first-time-mums, single pregnancy, feet-first (breech)

129

112 = 87%

7%

Group 7, not first-time-mums, single pregnancy, feet first (breech)

106

83 = 78%

5%

Group 8, women having multiple pregnancy

174

109 = 63%

7%

Group 9, presentations other than feet-first or head-first (eg shoulder)

In the right-hand column, we can see that groups 1, 2 and 5 are really driving our caesarean section rate. This was quite a surprise - we had not expected that groups 1 and 2 would be the real cause, because the women in these groups are not particularly complex. This means that our low risk / normal women are a significant factor contributing to our high caesarean section rate. This contradicts our initial assumption that a high caesarean section rate is connected with our complex women.

This means that if we want to reduce the caesarean section rate, it’s worthwhile to focus on the ‘normal’ women – especially the first time mums. In addition, the women who are induced have a greater likelihood of having a caesarean section – therefore we must carefully consider the appropriateness of induction of labour, and revise our induction of labour guidelines. We must also do further work to encourage women who have had a previous caesarean section to consider vaginal birth in their next pregnancy.